Nerve Injury During Treatment of the Proximal Humerus Fracture


Characteristics

Data

Absolute No.
 
 Fractures

143

 Sex
 
  Men

21

  Women

122

 Side
 
  Left

75

  Right

68

 Nerve injury

96

  Men

15

  Women

81

 Type of fracture (Neer class)
 
  I

93

  II

1

  IIIA

12

  IIIB

9

  IIIC

7

  IV2

5

  IV3

4

  IV4

3

  V2

1

  VI2A

2

  VI4A

2

  Caput

4

Means
 
 All fractures (n = 143)
 
  Age (years) (95 % CI)

68.8 (65.7, 71.9)

  Range

5–92

  Men

56.5

  Women

71

 With nerve injury (n = 96)
 
  Age (years) (95 % CI)

70.1 (68.0, 73.2)

  Range

13–91

  Men

53.9

  Women

73.1

 Nerves involveda
 
  Mean No. (95 % CI)

2.8 (2.5, 3.1)

  Mean maximum severity (95 % CI)

1.8 (1.6, 2.0)

  Mean severity/nerve (95 % CI)

1.6 (1.5, 1.7)


With the permission [2]

aCalculated per patient in 96 patients with nerve lesions



Most literature describes Nervus radialis lesions. De Franco et al. state that in general a radial nerve palsy may be defined as partial or complete. Complete motor loss occurs in approximately 50–68 % of cases [5] and [6]. Primary nerve palsies identified during the initial evaluation of the fracture occur at the time of the injury. Ten percent to 20 % of nerve palsies develop during the course of treatment. These are referred to as secondary radial nerve palsies [7, 8]. The extent of injury to peripheral nerves can be defined using Seddon’s classification system [4] (Table 27.2).


Table 27.2
Principal types of nerve injury [3, 4]
























































 
Neurotmesis

Axonotmesis

Neuropraxia

Pathologic
     

 Anatomic continuity

May be lost

Preserved

Preserved

 Essential damage
     

Clinical
     

 Motorparalysis

Complete

Complete

Complete

 Sensory paralysis

Complete

Complete

Usually much sparing

 Sympathetic paralysis

Complete

Complete

Usually much sparing

 Reaction of degeneration

Present

Present

Absent

 Nerve conduction below lesion

Lost

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May 13, 2017 | Posted by in ORTHOPEDIC | Comments Off on Nerve Injury During Treatment of the Proximal Humerus Fracture

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